Healthcare Provider Details

I. General information

NPI: 1366265712
Provider Name (Legal Business Name): ERICA ELIZABETH HAGOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD STE 60
ROCHESTER HILLS MI
48309-1729
US

IV. Provider business mailing address

4396 TIMBER LINE LN
GRAND BLANC MI
48439-9065
US

V. Phone/Fax

Practice location:
  • Phone: 248-608-4514
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: